Financial toxicity of cancer Current understanding and status of international and German research on objective financial burden and subjective financial distress

Background In Germany and many other countries, many cancer patients are affected by objective financial burden and subjective financial distress, which is often discussed internationally under the term "financial toxicity". Objectives Definition of financial toxicity, description of selected international measurement methods, correlations and results on risk factors are provided, and the evidence on financial burden for cancer patients in Germany is presented. Materials and methods Narrative review of international review papers on financial toxicity and of the current evidence on the financial consequences for cancer patients in Germany. Results and Discussion Financial toxicity describes both the objective financial burden due to medical costs and loss of income and the subjective financial distress. According to international literature, women, younger people, patients with low income and rural residence, and those with higher disease severity are at a higher risk for subjective financial distress. Possible consequences of financial toxicity include lower quality of life, more frequent depression and anxiety, nonadherence, and increased mortality. In Germany, cancer patients are also confronted with objective financial burden-especially loss of income-that can lead to financial distress. Up to 40% of cancer survivors in Germany report financial difficulties even years after diagnosis, affecting more frequently low-income patients and those who did not return to work or returned to work with reduced working hours.